HIV Treatment in Singapore

The outlook for people living with HIV has changed considerably over the years. Once associated with severe illness and a high fatality rate, HIV can now be effectively controlled with modern treatment. This makes starting and staying on treatment an important part of living well with HIV. With appropriate medication and ongoing medical care, the virus can remain under control while the risks to both short- and long-term health are reduced.

What Is HIV?

The human immunodeficiency virus (HIV) is a virus that damages the body’s immune system, rendering the body too weak to fight off infections and diseases effectively. Currently, there is no cure for HIV, but treatments such as antiretroviral therapy can alleviate symptoms and keep the virus under control, allowing patients to lead normal, healthier and longer lives. HIV screening in Singapore aims to catch the virus as early as possible and prevent it from developing into acquired immunodeficiency syndrome (AIDS).

What Is the Relationship Between HIV and AIDS?

HIV and AIDS are related, but they are not the same condition. HIV is the virus that attacks the immune system, while AIDS is the most advanced stage of HIV infection. Not everyone who has HIV has AIDS, and with effective treatment, many people living with HIV do not progress to AIDS.

Without treatment, HIV can gradually damage the immune system by reducing the number of CD4 cells, which play an important role in helping the body fight infections. As the immune system becomes severely weakened, a person can become vulnerable to certain opportunistic infections and cancers. HIV is considered to have progressed to AIDS when it reaches this advanced stage, based on factors such as a very low CD4 count or the development of certain AIDS-defining conditions.

Timely HIV screening and treatment are key to preventing the development of AIDS.

How Common Is HIV in Singapore?

The prevalence of HIV in Singapore is relatively low compared to many countries. According to the MOH report, the annual number of new HIV cases among Singapore residents had ranged from 300 to 500 from 2009 to 2019, and gradually decreased in the past few years.

The majority of HIV cases in Singapore are male, and, concerningly, over half are diagnosed at a late stage of infection. Sexual intercourse is the main mode of transmission, with roughly half of all recorded cases attributed to homosexual transmission.

What Are the Potential Complications of HIV If Left Untreated?

Untreated HIV can significantly weaken the immune system, making the body vulnerable to a range of serious and potentially life-threatening complications, including:

• HIV-Associated Dementia: In advanced stages, HIV can affect the brain, leading to HIV-associated dementia (also known as AIDS dementia complex), which impairs memory, concentration, and cognitive function.
• Cryptococcal Meningitis: A severe fungal infection of the brain and spinal cord, this condition can cause headaches, fever, and neurological symptoms, and may be fatal if not treated promptly.
• Pneumocystis Pneumonia (PCP): A common opportunistic infection in people with advanced HIV, PCP causes inflammation and fluid buildup in the lungs, leading to severe breathing difficulties.
• Tuberculosis (TB): HIV weakens the immune defences, increasing susceptibility to TB—a bacterial infection that primarily affects the lungs but can spread to other organs.
• Cytomegalovirus (CMV) Disease: This viral infection can damage multiple systems, including the brain, eyes, lungs, and digestive tract, leading to vision loss, cognitive decline, and respiratory complications.
• HIV-Associated Cancers: People living with HIV are at increased risk of certain cancers, such as Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer, due to prolonged immune suppression.

How Is HIV Diagnosed in Singapore?

HIV screening can be carried out through several ways, both at home and at a clinic. A common way to determine your HIV status is through a blood test, as symptoms are few and often not noticeable.

Diagnosis involves testing a blood sample for markers of HIV infection, such as HIV antibodies and antigens. Depending on the method used, a small blood sample may also be used for rapid testing.

If an initial result is reactive, further testing is required to confirm whether HIV is present. A reactive result on its own does not necessarily mean that a person has HIV.

After HIV is confirmed, the doctor may carry out further blood tests to assess the infection and the health of the immune system. These can include measuring the viral load, which indicates how much HIV is present in the blood, and the CD4 count, which provides information about immune function.

What Are the Treatment Options for HIV in Singapore?

Although there is currently no cure that can eliminate HIV from the body, treatment focuses on suppressing the virus and keeping it under control over the long term.

The main treatment for HIV is antiretroviral therapy (ART).

Antiretroviral Therapy (ART)

ART is the standard and most effective treatment for HIV, and it is recommended to begin as early as possible—ideally immediately after diagnosis. This therapy involves taking a combination of doctor-prescribed HIV medications that work to suppress the virus in the body. While ART does not cure HIV, it significantly reduces the viral load to undetectable levels, at which point the virus cannot be transmitted sexually.

The primary goals of ART are to control the virus, protect the immune system from damage, and reduce the risk of HIV transmission. With consistent treatment and adherence to medication, many HIV-positive individuals are able to live long, healthy, and fulfilling lives.

Even though a person living with HIV may feel completely well for years, it is recommended to start HIV treatment in Singapore as soon as possible. This is because even though it may not cause any symptoms in the first few years, an HIV infection causes chronic inflammation in the body and can cause health problems later in life.

What Are the Benefits of Starting HIV Treatment Early?

Starting HIV treatment as soon as possible after diagnosis can limit the damage the virus causes to the immune system and improve long-term health outcomes. Even if you feel well and have no noticeable symptoms, HIV can continue to affect the body without treatment.

The benefits of starting antiretroviral therapy (ART) early include:

• Protecting the immune system: Early treatment helps preserve CD4 cells and immune function, allowing the body to continue defending itself against infections.
• Reducing the risk of HIV-related illness: Starting ART early reduces the risk of serious AIDS-related and non-AIDS-related health problems compared with delaying treatment.
• Preventing progression to AIDS: By suppressing HIV and protecting immune function, ART can prevent HIV from progressing to its most advanced stage.
• Supporting better long-term health: Effective treatment allows people living with HIV to maintain their health and live long lives. Starting treatment earlier provides a better opportunity to maximise these benefits.
• Preventing sexual transmission: ART can reduce the viral load to an undetectable level. People who achieve and maintain an undetectable viral load do not sexually transmit HIV, commonly described as Undetectable = Untransmittable (U=U).

Starting treatment is only the beginning of long-term HIV care. Regular follow-up is also important to confirm that the virus remains suppressed, monitor immune function and ensure that your treatment continues to work effectively.

How Is HIV Monitored During Treatment?

HIV treatment requires regular follow-up to check that medication is suppressing the virus, monitor immune function and identify any treatment-related concerns. The frequency of these checks can vary according to your treatment stage, response to ART and overall health.

Monitoring typically includes:

1. Regular viral load testing: Viral load tests measure the amount of HIV in the blood. A falling viral load indicates that treatment is working, with the aim of reaching and maintaining an undetectable level.
2. CD4 count monitoring: CD4 cells are an important part of the immune system and are targeted by HIV. Monitoring the CD4 count helps assess immune function and how well it is recovering or being maintained during treatment.
3. Routine blood tests: Other blood tests may be performed to monitor areas such as liver and kidney function, blood cell counts and other health markers. These can help identify health concerns or effects associated with certain medications.
4. Medication reviews: Your doctor will review whether you are taking your medication consistently and check for possible interactions with other medicines or supplements. Your treatment regimen can also be reviewed if your circumstances or health needs change.
5. Assessing treatment effectiveness and side effects: Follow-up appointments provide an opportunity to discuss side effects or other difficulties with treatment. If the viral load is not adequately suppressed or side effects are difficult to manage, your doctor can investigate the cause and determine whether the treatment plan needs to be adjusted.

How Can HIV Be Prevented With PrEP and PEP?

Currently, there is no approved HIV vaccine, though extensive research continues. Until one becomes available, prevention strategies remain the most effective means of reducing HIV transmission.

Two important strategies include:

• HIV Pre-Exposure Prophylaxis (HIV PrEP)

  : A preventive approach for HIV-negative individuals at higher risk of infection. It involves taking two antiretroviral drugs daily or receiving long-acting injections to reduce the risk of acquiring HIV. PrEP users are also provided with comprehensive sexual health services, including STI screening and safer sex counselling.

• HIV Post-Exposure Prophylaxis (HIV PEP)

  : An emergency measure taken after potential exposure to HIV. It requires taking antiretroviral medication for 28 days to prevent the virus from establishing itself in the body. PEP must be started as soon as possible—ideally within two hours and no later than 72 hours after exposure—for maximum effectiveness.

Why Choose Dr Tan Medical Center for HIV Treatment?

Living with HIV requires ongoing care from a doctor who can support both effective treatment and your longer-term health. At Dr Tan Medical Center, Dr Tan Kok Kuan provides HIV treatment in a private and supportive setting, with care tailored to your individual needs.

With appropriate treatment and regular monitoring, HIV can be managed effectively over the long term. Our team is here to provide clear guidance and ongoing support throughout your care.

Contact us to discuss HIV treatment with Dr Tan and arrange an appointment.

Frequently Asked Questions About HIV Treatment